The report gives examples of how worker satisfaction and characteristics of the work environment affect patient outcomes, including: • Patient satisfaction levels were lower in hospitals with more nurses who are dissatisfied or burned out; • Lower perception of safety and teamwork among nurses was associated with increased odds of pressure ulcers in patients and increased nurse injury; • A higher nurse per patient ratio was associated with fewer patient falls.

An organizational safety climate was also found to reduce worker stress among high risk patients.

“Given that poorer safety culture and working conditions are associated with undesirable outcomes for workers, and undesirable worker outcomes are associated with poorer patient outcomes, it stands to reason that health care organizations preoccupied with safety should not focus on patient safety alone,” the report states.

The paper gives the hypothetical example of a hospital working towards reducing patient falls. The initiative includes reporting of “near miss” falls where a patient is not hurt. “A root cause analysis of these events might reveal that workers are getting injured instead because of their efforts to prevent patients from falling.” They suggest a multidisciplinary team may be able to identify solutions that prevent injury to both patients and workers.

While worker injuries and illnesses are on the decline in most sectors, the paper notes the reverse is true among U.S. health care support workers. Health care support workers are two and a half times more likely to experience non-fatal occupational injuries and illnesses than all private and public sector workers. The rate of musculoskeletal disorder cases among nursing aides, orderlies and attendants increased 10 per cent in 2010 to 249 cases per 10,000 workers, or seven times the general workforce.

The paper argues that redesigning processes in the workplace is more effective in decreasing errors than other interventions, including education, incentives and threats. “The goal of redesign (or re-engineering) of work process for safety is to make it harder to do the wrong thing and easier to do the right thing.”

Incident reporting is a critical component of that process, although the authors note that reporting must be safe – “individuals who report incidents must not be punished or suffer other ill effects from reporting.” The authors note that some employers unintentionally reward employees for not reporting errors or injuries by providing bonuses or parties when an injury-free period is completed.

To be effective the reporting system must include analysis and investigation components as well as identifying and implementing solutions.